By Chris Kelly

As a rambunctious nine year old, Antonio Centeno spent his after-school hours immersed in games or anchored to the television. Focusing on homework was another matter.

“My problem was being able to work without watching television” he recalled, adding that even, today, as an adult, “I just seem to gravitate to multi-tasking between two to three activities at a time.”

As concern mounted over her son’s learning issues, Centeno’s working mother faced a second challenge: limited time at home to help her son and no money for expensive medications that doctors often prescribe for attention-challenged children.

She found solution in Unitas, a group located near her neighborhood that connects children with Attention Deficit Hyper Activity Disorder, or ADHA, and other cognitive conditions to a network of caretakers and peers to teach communication and conflict resolution skills.

For over forty years, this program served as a cost-effective alternative to traditional medication for thousands of kids in the South Bronx. Today, as ADHD rates spiral upward, the techniques and treatments developed by Unitas are gaining wider interest.

More than over 4 million children have been diagnosed with this affliction since the 1980s when the diseases was first identified, while the prevalence of children ages eight to 15 having ADHD has risen from around three percent to nine percent of the child population, according to national health statistics.

Along with this rise has come a marked increase the prescription of medication. Nationally, there has been a 500% increase in the number of prescriptions written for ADHD since 1991, while the average cost of an ADHD drug has nearly doubled, from $39.03 in 1999 to $76.49 in 2003, according to a recent report.

Though Medicare and Medicaid have shouldered some of the burden of costs for low income families, what becomes of children who cannot afford medication?

One approach taken up through Unitas is addressing factors in a child’s unique social environment to build a network of community supporters.

“Unitas began as a result of a non-response to traditional mental health care for low income youth in the South Bronx,” explained Dr. Edward Eismann, a Columbia University trained psychologist and Unitas founder. “When I immersed myself in the neighborhood street and in the company of a child’s own social networks, the flood gates to connections and responsiveness opened.”

By engaging a child in that child’s environment, Eismann said he was able to use his clinical skills to help youth build helping relationships toward each other, creating a community of young people who became the watchdogs and caretakers of each other in a “therapeutic community.”

“And so I dubbed the organization Unitas Therapeutic Community by name. The word ‘Unitas’ meaning unity, comes from the Bible: ‘How good it is and how noble for people to live together in unity,’ ” he added.

Matching older caretakers with each Unitas child (usually beginning at the age of eight or nine), the Unitas program “mentors” each child to resolve conflicts and communicate without aggression.

The program focuses on developing self-control and self-esteem to compliment and lessen the need for traditional medication. Coming from single parent households, the program’s community focus is a drastic departure from the norm for many Unitas kids.

“Everytime that a conflict started you would see the caretakers sit the kids down at a table and talk out their differences” recalled Centeno, who is now employed as a teacher. “This was the first time I had actually seen work out their differences talking versus acting it out.”

During his three years in Unitas, Centeno says the program began every Thursday with the “family circle,” a gathering in which members of each symbolic family sit together. The symbolic parent, or head of household, is responsible for overseeing the caretaker system within their symbolic family. The children are invited to communicate, problem solve and contribute as resources for the good of all community members present.

The children are then given “caretaker” time to work on homework, play games and discuss individual issues.

For Centeno, a former who attended a parochial school in his neighborhood, the Unitas program served as the ideal outlet to better grades and shared experiences. “To this day I’m not really sure my mother understands what Unitas is all about, but she recognized the progress I made through the program, ” he said.

While never officially diagnosed with ADHD, Centeno says that only years later did he realize UNITAS was intended specifically for ADHD children. “Never did I feel as if I were different or singled out,” he said. “That was I choose to remember the program is sitting in the sun, having fun with my friends.”

Founder over forty years ago by Dr. Eismann, Centeno says the program’s community based approach lessens the need for medication by moderating extreme behaviors brought on by inattention.

“The reality of behavior is that it is influenced by others.” he explained. “This program has proven extreme behaviors associated with ADHD can be dramatically diminished by integrating the child atmosphere of support”

Starting with a few dozen children in the 1960s, the Unitas network has grown to help thousands of ADHD children reach their full potential. But with at least 85 percent of children diagnosed with ADHD treated with some form of stimulant medication, necessity continues the demand for a quick fix.

For Barbara, a mother of three on Manhattan’s Upper East Side, simply getting her three girls to the table at the same time proved a struggle. So when Becky, her youngest daughter, struggled to cope with the demands of kindergarten at Manhattan’s prestigious Loyola school, she decided to take no chances.

An inquisitive and well tempered child, Becky was never a problem for her teacher, but seemed unable to concentrate on her lessons at school. Every day after class, she would come home, immerse herself in the computer or games and block out a long day of self described “torture.”

Harkening back to similar problems in her own childhood, Barbara decided enough was enough. On the recommendation of her daughter’s teacher, she sought answers from a local psychiatrist.

“As a mother, it is difficult to work with Becky, go to Tracey’s soccer games and make sure Allie does her homework,” she explained. “When Becky started having trouble paying attention in class, I wanted to make sure she had the best treatment immediately”

Defined as impulsive behavior, an inability to concentrate and hyperactivity, ADHD seemed to perfectly fit Becky’s symptoms. But because these general symptoms are shared by many disorders, parents and clinicians alike find diagnosis difficult.

The American Psychiatric Association’s diagnostic manual, the DSM, lists 18 behaviors, from which a teacher can check off behaviors she observes in the potential patient or student. Likewise, the parent or caregiver does the same thing. In the current DSM, if one checks six or more of the nine, the individual is deemed to have ADHD.

To be sure, Barbara was able to foot the expense of a detailed evaluation—which includes a full battery of tests and two to three follow up sessions. According to Sejal Vyas, a clinical neural-psychiatrist in Manhattan, such evaluations—crucial to proper diagnosis– typically run anywhere from $2000-3500 dollars.

“Often the hyperactive – impulsive symptoms in children may be at risk for a wrongful diagnosis of a Childhood Bipolar Disorder—making intervention from an experienced professional imperative,” explained Vyas, who often continues to treat older children who have had a history of ADHD, who no longer show the symptoms, as a follow up to medication.

As the first step in the treatment process, Vyas says medication helps to suppress short term symptoms while cognitive therapy administered by a psychologist treats the longer term causes.

And sure enough, after being prescribed Ritalin in conjunction with behavioral therapy, Becky exhibited an almost immediate improvement in her learning and language skills.

But after speaking with at least seven other parents whose children were on medication, what baffled Barbara—who exhibited many of Becky’s problem growing up– is that ADHD was never mentioned during her school experience. But this comes as no surprise to many experts who say better diagnosis and treatment have led to greater prescriptions.

“ADHD started to be diagnosed by that name about 25 years ago; since then, as physicians and psychologists have gained more knowledge about the disorder, diagnoses have risen,” said Susan Caughman, editor of ADDitude Magazine, a publication covering ADHD treatment and symptoms. “Prescriptions rise as diagnoses rise, as there is a body of research to support the positive impact of a treatment plan including medication for people diagnosed with ADHD.”

Even with the risks—side effects including depression, cardiovascular disease, and addiction, medication and the dangers of stimulant medication such as depression, cardiovascular disease, and addiction — Barbara is just happy to see Becky getting help. But even she sometimes questions paying $78 dollars for a 30 day supply of Adderall, on top of the $250 dollars per visit for behavioral therapy– indicating the cost of medication has risen “at least twenty dollars in the last two years.”

How did the marked growth of ADHD diagnosis and medication use begin? In 1987, an H was added to the label and the illness became, “Attention Deficit Hyperactivity Disorder.” Within one year, 500,000 children in the US were diagnosed with this disorder.

A few years later, it was classified as a disability and a cash incentive program was initiated for low-income families with children diagnosed with ADHD. A family could get $450 a month for each child diagnosed with the disorder, and the cost of treatment and medication would be covered by Medicaid and most major insurances.

Then in 1991, schools began receiving educational grants of $400 annually for each ADHD child. The same year, the US Department of Education classified the disorder as a handicap, which required special services to be provided to each disabled child.

Today, the annual cost for ADHD is $77 billion and the annual cost for drug use is $58 billion. In recent years, these growing numbers have led many experts to speculate that economic status may increasingly influence diagnosis.

“To the extent that diagnoses appear more in one neighborhood or another, that’s going to be driven by affluence leading in turn to more frequent visits to pediatricians and other health professionals, thus leading to greater likelihood of diagnosis,” said Caughman.

While no statistics exist on the prevalence of ADHD between New York City communities, a quick scan of the local yellow pages revealed a staggering 194 practicing psychiatrists within a one mile vicinity of Manhattan’s Upper East side compared to a mere eighteen in Centone’s the South Bronx community.

These numbers come as no surprise to Unitas founder Eismann. “Cost for psychotropic medications is outrageous and for the bulk of middle class America a cost is incurred under great sacrifice.” said Eismann. “My stance on the use of medication for ADHD is the same as that regarding any psychotropic drug: Hyper cautious.”

Eismann says by focusing on the psychological, social and environmental components experienced by children, there is a lessening need of medication, even to its elimination in less than severe case because the emphasis is on self control, being in charge of oneself and the impact of the influence of the caretaker network of Unitas in reinforcing this capacity.

Because ADHD is the product of extreme behavior, the goal of the program is to help youngsters find balance in the middle somewhere being neither unduly inhibited nor unduly aggressive. While Eismann insisted he is not “anti-medication,” his stated objective is to also help children find this balance through a variety of options.

“If medications are used because they are quick fixes to satisfy social controls, one is deluded into thinking that a true solution is found,” he said. “But to find that a particular low dose medication for a particular person truly helps together with interventions of a rich psychosocial nature is addressing the person holistically.”

While Unitas has never formally expanded organizationally into other neighborhoods, its thousands of youth participants, many of whom entered social service professions and the many who served as interns over 40 years from schools of social work and departments of psychology and psychiatry, have brought what they experienced and learned into their professional practice.

Centeno says the training he received in Unitas later allowed him to recognize and positively influence ADHD children as a religion teacher. Today as a member of the

“Often eight or nine year olds who begin as Unitas kids become caretakers themselves,” he explained. “That is how a family is, older brothers and sisters coming back to take care of their own.”